Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom.
PLoS Negl Trop Dis. 2012;6(8):e1760. doi: 10.1371/journal.pntd.0001760. Epub 2012 Aug 7.
Dengue is a growing problem both in its geographical spread and in its intensity, and yet current global distribution remains highly uncertain. Challenges in diagnosis and diagnostic methods as well as highly variable national health systems mean no single data source can reliably estimate the distribution of this disease. As such, there is a lack of agreement on national dengue status among international health organisations. Here we bring together all available information on dengue occurrence using a novel approach to produce an evidence consensus map of the disease range that highlights nations with an uncertain dengue status.
METHODS/PRINCIPAL FINDINGS: A baseline methodology was used to assess a range of evidence for each country. In regions where dengue status was uncertain, additional evidence types were included to either clarify dengue status or confirm that it is unknown at this time. An algorithm was developed that assesses evidence quality and consistency, giving each country an evidence consensus score. Using this approach, we were able to generate a contemporary global map of national-level dengue status that assigns a relative measure of certainty and identifies gaps in the available evidence.
The map produced here provides a list of 128 countries for which there is good evidence of dengue occurrence, including 36 countries that have previously been classified as dengue-free by the World Health Organization and/or the US Centers for Disease Control. It also identifies disease surveillance needs, which we list in full. The disease extents and limits determined here using evidence consensus, marks the beginning of a five-year study to advance the mapping of dengue virus transmission and disease risk. Completion of this first step has allowed us to produce a preliminary estimate of population at risk with an upper bound of 3.97 billion people. This figure will be refined in future work.
登革热在地域传播和强度方面都呈增长趋势，但目前其全球分布仍高度不确定。诊断和诊断方法方面的挑战以及各国高度可变的卫生系统意味着，没有单一的数据来源能够可靠地估计这种疾病的分布。因此，国际卫生组织之间对各国登革热的现状存在分歧。在这里，我们采用一种新方法汇集了所有关于登革热发生的可用信息，以制作一张疾病范围的证据共识图，突出那些登革热现状不确定的国家。
方法/主要发现：使用基线方法评估每个国家的一系列证据。在登革热状况不确定的地区，纳入了额外的证据类型，以明确登革热的状况或确认目前尚不清楚。开发了一种算法，用于评估证据质量和一致性，为每个国家分配一个证据共识评分。使用这种方法，我们能够生成一张具有当代性的国家级登革热现状全球地图，该地图对确定性进行了相对衡量，并确定了现有证据中的空白。
这里制作的地图列出了 128 个有充分证据表明存在登革热的国家，其中包括 36 个以前被世界卫生组织和/或美国疾病控制与预防中心归类为无登革热的国家。它还确定了疾病监测需求，我们完整列出了这些需求。使用证据共识确定的疾病范围和界限，标志着一项为期五年的研究的开始，以推进登革热病毒传播和疾病风险的绘图。完成这第一步使我们能够初步估计高危人群，上限为 39.7 亿人。这个数字将在未来的工作中进一步细化。
